The leaders of three unions representing more than 5,000 nurses joined forces Thursday at the state Capitol to rally for legislation ensuring safer standards of staffing at Hawaii hospitals.

Specifically, they rallied for mandated nurse-to-patient ratios — basically, limits on how many patients a nurse cares for at one time — to be implemented through statewide legislation rather than through lengthy, individual contract negotiations.

State Rep. Sean Quinlan (D, Waialua-Haleiwa-Punaluu) announced plans to introduce a bill establishing enforceable ratios, along with accountability in hospital staffing practices.

The bill would not only seek staffing ratios for various hospital units, but mandate nurse-led staffing committees and oversight by the state Department of Labor and Industrial Relations. A Senate bill addressing the issue in 2024 died early in the session.

“Unfortunately, I know from my own experience in my life that nurses are such a critical part of any stay in a hospital, especially an extended stay,” Quinlan said. “And I want to make sure that the public understands that this is not about nurses. This is about the patients that they serve.”

The past year has been fraught with conflict over staffing ratios — with strikes held by nurses at Kapi‘olani Medical Center for Women &Children, then at Maui Health hospitals, including Maui Memorial Medical Center.

A strike involving more than 1,900 nurses was recently averted at The Queen’s Medical Center. Nurses at Wilcox Medical Center on Kauai, meanwhile, were striking for the third day Thursday as the rally was being held.

The Hawaii Nurses’ Association, which represents nurses at Kapi‘olani, Queen’s and Wilcox, put its support behind similar legislation in 2024.

HNA stood shoulder to shoulder with leaders of the United Nurses and Health Care Employees of Hawaii, which represents workers at Maui Health, and Hawaii Nurses and Healthcare Professionals, which represents nurses at Kaiser, at the Capitol Rotunda in support of the bill.

They said the legislation is needed to improve patient safety and reduce nurse burnout — and that states with laws, such as California, have seen improved patient outcomes.

Hospital leaders have pushed back against the concept of fixed ratios, saying they must remain flexible to adapt to patients’ changing needs and that sticking to ratios could lead to unintended consequences, such as having to turn away patients.

But HNA President Rosalee Agas-Yuu said a momentum of support is building after the past year’s events.

The Kapi‘olani strike was followed by an indefinite lockout by management and the arrest of 10 community activists protesting the lockout before an agreement was reached last fall with the help of federal mediators.

“After years of fighting for change, we are finally seeing progress that puts patients at the center of health care reform,” Agas-Yuu said. “In recent months all of us as separate unions have taken on fights for safe staffing, and today, for the first time, we are uniting to make history in Hawaii.”

Terilyn Carvalho Luke, president of HNHP, which represents more than 1,000 nurses at Kaiser Permanente, said the legislation is needed.

“Simply put, this will keep our patients safe throughout our state,” she said. “When patients are being cared for by nurses who are stretched too thin, then our patients aren’t receiving the care that they deserve. When our nurses are overburdened, the consequences are severe.”

Studies show that lower nurse-staffing levels are associated with higher patient mortality rates, increased complications and longer hospital stays, she said.

Also, high patient loads lead to burnout and mental health struggles for nurses, and have caused them to leave the bedside in Hawaii.

“It is not uncommon for our patients to have a nurse who is working a 12-hour shift without a break while trying to manage as many as seven patients in acute care,” she said. “This is not the best care that our patients deserve, and we can’t hope to retain or attract nurses to our profession under these working conditions.”

Charmaine Morales, UNHCEH president, said patients are not just number on a profit-and-loss statement, but neighbors, teachers and friends.

“No matter how committed, dedicated and skilled our nurses are, we alone cannot overcome the dangers of understaffing,” she said. “We urgently need the help of health care providers and local government — and let’s be clear, understaffing has brutal effects.”

Approximately 160 nurses at Wilcox are expected to return to work this morning after the strike.

The nurses there reached an impasse with management over ratios in the medical-­surgical unit. Wilcox nurses want a ratio of 1 nurse to 5 patients, at most, instead of 6 to 7 patients, bringing it in line with standards at Oahu hospitals.

The unions said nurses statewide should work under the same standards.

“I feel very strongly that whatever island you’re on or whatever hospital you’re in in Hawaii, that you deserve the same standard of care as everybody else,” Quinlan said.